BAYRAM KELLE, MUSTAFA ERKAN KOZANOĞLU, ÖMER SUNKAR BİÇER, İsmet TAN

Association between phantom limb complex and the level of amputation in lower limb amputee

Objective: The aim of this study was to evaluate the natural course of phantom limb complex withoutany treatment after lower limb amputation.Methods: The study design was consisted of a combination of retrospective review and cross-sectionalinterview. 101 patients with lower limb amputation were included into the study. Patients weredivided into three groups according to the amputation level: i) from hip disarticulation to knee disarticulation (including knee disarticulation) (25 patients, mean age: 55.9, 19 males, 6 females) ii) transtibialamputation (below knee to ankle including ankle disarticulation) (41 patients, mean age: 58.6, 33 males,8 females) iii) below ankle to toe amputation (35 patients, mean age: 58.7, 26 males, 9 females). Thepatients were evaluated on both early postoperative period (EPP) and sixth months after the surgery(ASM). The data related amputation including amputation date, level, cause, stump pain (SP), phantomlimb pain (PLP), components of PLP, phantom sensation (PS) were recorded based on the informationobtained from patients' and hospitalŞles.Results: Statistically signiŞcant differences were found for pain intensity (VAS) between groups for SPand PLP at EPP (p< 0.001, p ¼ 0.036; respectively). The mean VAS score in Group I for SP and PLP washigher than other groups. This differences for SP and PLP did not continue at ASM assessment (p¼ 0.242,p¼ 0.580; respectively).Conclusion: VAS scores for SP in above knee amputations and VAS scores for PLP in above knee amputations and below ankle amputations were higher at EPP. But these high scores had disappeared overtime. Management strategies have to be considered particularly in the early postoperative period inpatients who had undergone above knee amputation.Level of Evidence: Level III Prognostic study.© 2017 Turkish Association of Orthopaedics and Traumatology. Publishing services by Elsevier B.V. This isan open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

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Casale R, Alaa L, Mallick M, Ring H. Phantom limb related phenomena and their rehabilitation after lower limb amputation. Eur J Phys Rehabil Med. 2009;45: 559e566.

Nikolajsen L, Jensen TS. Phantom limb pain. Br J Anaesth. 2001;87:107e116.

Giummarra MJ, Moseley GL. Phantom limb pain and bodily awareness: current concepts and future directions. Curr Opin Anaesthesiol. 2011;24:524e531.

Wolff A, Vanduynhoven E, van Kleef M, Huygen F, Pope JE, Mekhail N. 21. Phantom pain. Pain Pract. 2011;11:403e413.

Weeks SR, Anderson-Barnes VC, Tsao JW. Phantom limb pain: theories and therapies. Neurologist. 2010;16:277e286.

Nikolajsen L, Ilkjaer S, Kroner K, Christensen JH, Jensen TS. The influence of preamputation pain on postamputation stump and phantom pain. Pain. 1997;72:393e405.

Jensen TS, Krebs B, Nielsen J, Rasmussen P. Immediate and long-term phantom limb pain in amputees: incidence, clinical characteristics and relationship to pre-amputation limb pain. Pain. 1985;21:267e278.

Bosmans JC, Geertzen JH, Post WJ, van der Schans CP, Dijkstra PU. Factors associated with phantom limb pain: a 31/2-year prospective study. Clin Rehabil. 2010;24:444e453.

Dijkstra PU, Geertzen JH, Stewart R, van der Schans CP. Phantom pain and risk factors: a multivariate analysis. J Pain Symptom Manage. 2002;24:578e585.

Ramachandran VS, Hirstein W. The perception of phantom limbs. The D. O. Hebb lecture. Brain. 1998;121:1603e1630.

Hsu E, Cohen SP. Postamputation pain: epidemiology, mechanisms, and treatment. J Pain Res. 2013;6:121e136.

Le Feuvre P, Aldington D. Know pain know gain: proposing a treatment approach for phantom limb pain. J R Army Med Corps. 2014;160:16e21.

Sherman RA, Sherman CJ. Prevalence and characteristics of chronic phantom limb pain among American veterans. Results of a trial survey. Am J Phys Med. 1983;62:227e238.

Clark RL, Bowling FL, Jepson F, Rajbhandari S. Phantom limb pain after amputation in diabetic patients does not differ from that after amputation in nondiabetic patients. Pain. 2013;154:729e732.

Hunter JP, Katz J, Davis KD. Stability of phantom limb phenomena after upper limb amputation: a longitudinal study. Neuroscience. 2008;156:939e949.

Hunter JP, Katz J, Davis KD. Dissociation of phantom limb phenomena from stump tactile spatial acuity and sensory thresholds. Brain. 2005;128:308e320.

Richardson C, Glenn S, Nurmikko T, Horgan M. Incidence of phantom phe- nomena including phantom limb pain 6 months after major lower limb amputation in patients with peripheral vascular disease. Clin J Pain. 2006;22: 353e358.

Hanley MA, Jensen MP, Smith DG, Ehde DM, Edwards WT, Robinson LR. Pre- amputation pain and acute pain predict chronic pain after lower extremity amputation. J Pain. 2007;8:102e109.

Richardson C, Crawford K, Milnes K, Bouch E, Kulkarni J. A clinical evaluation of postamputation phenomena including phantom limb pain after lower limb amputation in dysvascular patients. Pain Manag Nurs. 2015;16:561e569.

Kooijman CM, Dijkstra PU, Geertzen JH, Elzinga A, van der Schans CP. Phantom pain and phantom sensations in upper limb amputees: an epidemiological study. Pain. 2000;87:33e41.

Schley MT, Wilms P, Toepfner S, et al. Painful and nonpainful phantom and stump sensations in acute traumatic amputees. J Trauma. 2008;65:858e864.

Mac Iver K, Lloyd D. Management of phantom limb pain. In: Murray C, ed. Amputation, Prosthesis Use, and Phantom Limb Pain. An Interdisciplinary Perspective. New York: Springer; 2010:157e173.